AB0306 PNEUMOCOCCAL VACCINATION REDUCES THE RISK OF RESPIRATORY INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TARGETED THERAPY. DATA FROM MOSCOW UNIFIED ARTHRITIS REGISTRY (MUAR)
Authors: E. Zhilyaev, G. Lukina, E. Koltsova, D. Murtazalieva, E. Shmidt, K. Lytkina, A. Shmitko, D. Blagovidov, M. Kostinov
Journal: Annals of the Rheumatic Diseases (2022)

Background The incidence of infections, mainly pneumonias, is significantly increased in patients with rheumatoid arthritis (RA). The risk increases more in persons treated with targeted anti-inflammatory drugs (tDMARDs), biological or targeted synthetic. Pneumococcal vaccination is recommended for most patients with rheumatic diseases. However, only the immunological effectiveness of such vaccination has been sufficiently confirmed. There is sparse evidence of its clinical efficacy in patients with rheumatic diseases. Objectives to evaluate the effect of 23-valent pneumococcal polysaccharide vaccine (PPV23) and 13-valent pneumococcal conjugate vaccine (PCV13) on the risk of infections in RA patients receiving tDMARDs. Methods The data from the Moscow Unified Arthritis Registry (MUAR) for the period 2018-2020 were analyzed. We included patients with RA, over 18 years old, received tDMARDs (all available biologics or tofacitinib). The analysis included episodes of observation from the moment of vaccination with pneumococcal vaccine until the development of the analyzed event (any infection, respiratory infection or serious infection) or until the end of follow up. For unvaccinated patients, episodes began since October 20, 2018 (the average date of vaccination of persons who received immunization). The risks were compared using Cox regression. An adjustment was made for confounders identified in an earlier study: age and smoking. Results The analysis included 832 patients: 40 were vaccinated with PCV13, 35 – with PPV23. There were 144 men (17.3%). The mean age was 55.4 ± 12.1 years. The duration of observation was 319 ± 198 days. A total of 237 infectious events were registered, of which 201 were respiratory and 21 serious (Table 1). There was a significantly lower risk of any infection (relative risk (RR) – 0.39 CI: 0.18 - 0.84, p = 0.015) and the risk of respiratory infection (RR - 0.32; CI: 0.13 -0.79; p = 0.014) in the group of patients vaccinated with PCV13 compared with unvaccinated. The differences remained statistically significant after adjusting for the age and smoking, Figure 1. Table 1. Registered infectious events Event groups Localisation Number Of them serious Respiratory infections Ear, paranasal sinuses, tonsils 16 2 Upper respiratory tract 166 0 Pneumonia 18 14 Lung abscess 1 1 Other infections Eye and appendages 3 0 Skin and subcutaneous tissue 7 1 Bones and joint 2 2 Urogenital tract 6 0 Digestive system, including the oral cavity 2 1 Herpes infections* 16 0 * - events are included in the group, regardless of localization, these events were not included in other sections Figure 1. Survival without infectious events (A) and without respiratory infections (B) adjusted for age and smoking The interaction of the effects of vaccination with the factor of the used tDMARD, as well as with the factor of the use of methotrexate in their effect on the risk of any and respiratory infections was evaluated. There was no significant interaction between these variables. There were no significant differences in the risk of serious infections due to a small number of events of this kind. No serious infections were registered among patients vaccinated with PCV13. Conclusion Vaccination with 13-valent conjugated pneumococcal vaccine in patients with rheumatoid arthritis receiving tDMARDs can significantly reduce the risk of infectious complications, mainly due to acute respiratory infections. We found no significant effect of targeted drug and treatment with methotrexate on the effectiveness of vaccination. Disclosure of Interests Evgeniy Zhilyaev Speakers bureau: UCB Pharma, Biocad, Galina Lukina Speakers bureau: Pfizer, MSD, Biocad, Ekaterina Koltsova: None declared, Dzhamilya Murtazalieva: None declared, Evgeniya Shmidt: None declared, Karine Lytkina Speakers bureau: UCB Pharma, Anna Shmitko: None declared, Dmitry Blagovidov: None declared, Mikhail Kostinov: None declared